title: Monthly screening for BK viremia is an effective strategy to prevent BK virus nephropathy in renal transplant recipients.
abstract: BACKGROUND
  BK polyomavirus virus (BKV) nephropathy (BKVN) is the most common viral infection that affects renal allografts. Because a specific antiviral therapy is lacking, BKVN may result in graft dysfunction and/or loss. We prospectively analyzed whether monthly nucleic acid testing (NAT) for BKV replication in blood and immediate reduction of immunosuppression (IS) could prevent BKVN.
  
  
  METHODS
  NAT was performed at monthly intervals for 6 months and then at 12 months in 119 de novo renal transplant recipients. In viremic patients (presumptive BKVN), a graft biopsy was systematically performed and IS was immediately reduced.
  
  
  RESULTS
  BKV viremia occurred in 13 (10.9%) patients after a median time of 90 days (23-241); 77% of patients were viremic before month 4. After reduction of IS, viral load was undetectable in 11 patients, remained low in 1, and continued to increase in 1 patient who developed definitive BKVN despite reduction of IS, and finally returned to dialysis 6 months after transplantation.
  
  
  CONCLUSIONS
  BKV infection is an early complication. Monthly NAT in blood during the first 6 months and immediate reduction of IS in viremic patients almost completely prevent definitive BKVN.
authors.affiliation: Department of Nephrology and Transplantation, Hôpital Lapeyronie, University of Montpellier Medical School, Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Alméras
authors.forename: F
authors.initials: F
authors.lastname: Vetromile
authors.forename: V
authors.initials: V
authors.lastname: Garrigue
authors.forename: I
authors.initials: I
authors.lastname: Szwarc
authors.forename: V
authors.initials: V
authors.lastname: Foulongne
authors.forename: G
authors.initials: G
authors.lastname: Mourad
mesh_terms: D000328:Adult; D001739:BK Virus / Q000302:isolation & purification*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000097:blood / Q000517:prevention & control / Q000821:virology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000097:blood / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D014412:Tumor Virus Infections / Q000097:blood / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D019562:Viral Load; D014766:Viremia; D014779:Virus Replication
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents